Bone anchor assemblies

ABSTRACT

A bone anchor assembly includes a bone anchor, a receiver member for receiving a spinal fixation element to be coupled to the bone anchor, a compression member positioned within the receiver member, and a closure mechanism including an outer set screw and an inner set screw. The outer set screw delivers a distal force to the compression member to fix the bone anchor relative to the receiver member. The proximal surface of the compression member has a shape configured to restrict deformation of the compression member arms including motion of the compression member arms relative to each other. The distal surface of the outer set screw has a shape that is complementary to the shape of the proximal surface of the compression member.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No. 14/029,005, filed Sep. 17, 2013, which claims priority to U.S. Provisional Patent Application No. 61/707,062, filed Sep. 28, 2012, for which both are incorporated herein by reference.

BACKGROUND

Bone anchors may be used in orthopedic surgery to fix bone during the healing or fusion process. In spinal surgery, bone anchors may be used with spinal fixation elements, such as spinal rods, to stabilize multiple vertebrae either rigidly, in which no relative motion between the vertebrae is desired, and dynamically, in which limited, controlled motion between the vertebrae is desired. A closure mechanism is typically used to secure the spinal fixation element between two spaced apart arms of the receiver member of the bone anchor. In certain bone anchor assemblies, the spinal fixation element is also positioned between the spaced apart arms of a compression member positioned within the receiver member. Tightening of the closure mechanism can cause deformation of the components of the bone anchor assembly including, for example, the receiver member or the compression member. Such deformation can cause the arms of the receiver mechanism or the arms of the compression member to separate or splay, which can result in the closure mechanism loosening over time and, in the worst case, the spinal fixation element separating from the bone anchor assembly.

Accordingly, there is a need for improved bone anchor assemblies in which deformation of the components of the assembly is minimized during tightening.

SUMMARY

Disclosed herein are improved bone anchor assemblies and, in particular, improved bone anchor assemblies used in connection with spinal fixation elements to fix multiple vertebrae.

In accordance with one aspect, a bone anchor assembly includes a bone anchor having a proximal head and a distal shaft configured to engage bone, a receiver member for receiving a spinal fixation element to be coupled to the bone anchor, a compression member positioned within the central passage of the receiver member, an outer set screw, and an inner set screw.

The receiver member has a proximal end, a distal end, and a central passage. The proximal end of the receiver member has a pair of spaced apart receiver member arms defining a recess therebetween and the receiver member arms may include an inner thread. The distal end of the receiver member has a distal end surface defining opening through which at least a portion of the bone anchor extends. The central passage extends between the proximal end and the distal end and communicates with the opening in the distal end surface. The central passage has a central longitudinal axis extending between the proximal end and the distal end.

The compression member has a proximal end and a distal end. The proximal end of the compression member has a pair of spaced apart compression member arms defining a U-shaped seat for receiving the rod. Each compression member arm has a proximal surface. The distal end of the compression member has a distal surface engageable with the proximal head of the bone anchor.

The outer set screw includes a first outer thread for engaging the first inner thread of the receiver member arms. The outer set screw has a distal surface engageable with the proximal surfaces of the compression member arms and a set screw central passage from a top surface of the outer set screw to a bottom surface of the outer set screw. The set screw central passage has a second internal thread.

The inner set screw is positionable within the set screw central passage and has a second outer thread for engaging the second inner thread of the outer set screw. The inner set screw is operable to act on the spinal rod to fix the spinal rod relative to the receiver member.

Engagement of the outer set screw with the receiver member arms results in the distal surface of the outer set screw engaging the proximal surface of the compression member arms and the outer set screw thereby delivering a distal force to the compression member to fix the bone anchor relative to the receiver member. The proximal surface of the compression member arms has a shape configured to resist deformation of the compression member arms and, in particular, to restrict relative movement of the compression member arms both towards and away from each other. The distal surface of the outer set screw has a shape that is complementary to the shape of the proximal surface of the compression member arms.

BRIEF DESCRIPTION OF THE FIGURES

These and other features and advantages of the devices and methods disclosed herein will be more fully understood by reference to the following detailed description in conjunction with the attached drawings in which like reference numerals refer to like elements through the different views. The drawings illustrate principles of the devices and methods disclosed herein and, although not to scale, show relative dimensions.

FIG. 1 is an exploded, perspective view of an exemplary embodiment of a bone anchor assembly;

FIG. 2 is an exploded view in cross section of the bone anchor assembly of FIG. 1;

FIG. 3 is a side view in cross section of the bone anchor assembly FIG. 1;

FIG. 4 is a perspective view of the compression member of the bone anchor assembly of FIG. 1;

FIG. 5 is a cross sectional view of the compression member of the bone anchor assembly FIG. 1;

FIG. 6 is an exploded view in cross section of another exemplary embodiment of a bone anchor assembly;

FIG. 7 is a side view in cross section of the bone anchor assembly of FIG. 6;

FIG. 8 is a perspective view of the compression member of FIG. 6;

FIG. 9 is a side view in cross section of the compression member of FIG. 6;

FIG. 10 is an exploded view in cross section of another exemplary embodiment of a bone anchor assembly;

FIG. 11 is a side view in cross section of the bone anchor assembly of FIG. 6;

FIG. 12 is a perspective view of the compression member of FIG. 6;

FIG. 13 is a side view in cross section of the compression member of FIG. 6;

FIG. 14 is a side view in cross section of another exemplary embodiment of a bone anchor assembly;

FIGS. 15-25 are side views in cross section of other exemplary embodiments of a bone anchor assembly; and

FIG. 26 is a side view in cross section of a prior art bone screw assembly.

DETAIL DESCRIPTION OF EXEMPLARY EMBODIMENTS

Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.

The articles “a” and “an” are used herein to refer to one or to more than one (i.e. to at least one) of the grammatical object of the article. By way of example, “an element” means one element or more than one element.

The terms “comprise,” “include,” and “have,” and the derivatives thereof, are used herein interchangeably as comprehensive, open-ended terms. For example, use of “comprising,” “including,” or “having” means that whatever element is comprised, had, or included, is not the only element encompassed by the subject of the clause that contains the verb.

FIGS. 1-5 illustrate an exemplary embodiment of a bone anchor assembly 10 including a bone anchor 12, a receiver member 14 for receiving a spinal fixation element, such as a spinal rod 22, to be coupled to the bone anchor 12, and a closure mechanism 16 to capture a spinal fixation element within the receiver member 14 and fix the spinal fixation element with respect to the receiver member 14. The bone anchor 12 includes a proximal head 18 and a distal shaft 20 configured to engage bone. The receiver member 14 has a proximal end 26 having a pair of spaced apart receiver member arms 28A, 28B defining a recess 30 therebetween and a distal end 32 having a distal end surface 34 defining opening 33 through which at least a portion of the bone anchor 12 extends. The closure mechanism 16 may be positionable between and may engage the arms 28A, 28B to capture a spinal fixation element, e.g., spinal rod 22, within the receiver member 14 and fix the spinal fixation element with respect to the receiver member 14.

Continuing to refer to FIGS. 1-5, the proximal head 16 of the bone anchor 12 in the exemplary embodiment is generally in the shape of a truncated sphere having a planar proximal surface 36 and an approximately spherically shaped distal surface 38. The exemplary bone anchor assembly is a polyaxial bone screw designed for posterior implantation in the pedicle or lateral mass of a vertebra. In this regards, the proximal head 18 of the bone anchor 12 engages the distal end 32 of the receiver member 14 in a ball and socket like arrangement in which the proximal head 18, and thus the distal shaft 20, can pivot relative to the receiver member 14. The distal surface 38 of the proximal head 18 of the bone anchor 12 and the mating surface within the distal end 32 of the receiver member 14 may have any shape that facilitates this ball and socket like arrangement, including, for example, spherical (as illustrated), toroidal, conical, frustoconical, and any combinations of these shapes.

[33] The distal shaft 20 of the bone anchor 12 may be configured to engage bone and, in the illustrated embodiment, includes an external bone engaging thread 40. The thread form for the distal shaft 20, including the number of threads, the pitch, major and minor diameter, and thread shape, may be selected to facilitate connection with bone. Examples of exemplary thread forms are disclosed in U.S. Patent Application Publication No. 2011-0288599, filed May 18, 2011, and U.S. Patent Application Publication No. US 2013-0053901, filed Aug. 22, 2012, both of which are incorporated herein by reference. Alternatively, the distal shaft 20 may include other structures for engaging bone, including a hook. The distal shaft 20 of the bone anchor 12 may be cannulated, having a central passage or cannula extending the length of the bone anchor to facilitate delivery of the bone anchor over a guide wire in, for example, minimally invasive procedures. The other components of the bone anchor assembly, including the closure member 16, the receiver member 14, and the compression member 60 (discussed below) may be cannulated or otherwise have an opening to permit the respective component to be delivered over a guide wire. The distal shaft 20 may also include one or more side wall openings or fenestrations that communicate with the cannula to permit bone in-growth or to permit the dispensing of bone cement or other materials through the bone anchor 10. The side wall openings may extend radially from the cannula through the side wall of the distal shaft 20. Exemplary systems for delivering bone cement to the bone anchor assembly 10 and alternative bone anchor configurations for facilitating cement delivery are described in U.S. Patent Application Publication No. 2010/0114174, which is hereby incorporated herein by reference. The distal shaft 20 of the bone anchor 12 may also be coated with materials to permit bone growth, such as, for example, hydroxyl apatite, and the bone anchor assembly 10 may be coated all or in-part with anti-infective materials, such as, for example, tryclosan.

Continuing to refer to FIGS. 1-5, the proximal end 26 of the receiver member 14 of the exemplary bone anchor assembly 10 includes a pair of spaced apart arms 28A, 28B defining the U-shaped recess 30 therebetween for receiving a spinal fixation element. e.g., a spinal rod. Each receiver member arm 28A, 28B of the proximal end 26 of the receiver member 14 extends from the distal end 32 of the receiver member 14 to a free end. The outer surface of each arm 28A, 28B may include a feature, such as a recess, dimple, notch, projection, or the like, to facilitate connection of the receiver member 14 and, thus, the bone anchor assembly 10, to instruments. For example, the outer surface of each arm 28A, 28B may include an arcuate groove 35 at the respective free end of the arms. Such grooves are described in more detail in U.S. Pat. No. 7,179,261, which is incorporated herein by reference. At least a portion of the proximal end surface 48 of the receiver member 12 defines a plane Y, as illustrated in FIG. 3.

The distal end 32 of the receiver member 14 includes a distal end surface 34 which is generally annular in shape defining a circular opening through which at least a portion of the bone anchor 12 extends. For example, the distal shaft 20 of the bone anchor 12 may extend through the opening. At least a portion of the distal end surface 34 defines a plane X.

The receiver member 14 includes a central passage 37 extending between the proximal end 26 and the distal end 32. The central passage 37 communicates with the opening 33 in the distal end surface 34 of the distal end 32 of the receiver member 14. The central passage 37 and the receiver member 14 having a common central longitudinal axis L extending between the proximal end 26 and the distal end 32 of the receiver member 14.

The exemplary bone anchor assembly is a rigid polyaxial screw in which the bone anchor 12 can be selectively fixed relative to the receiver member 14. Prior to fixation, the bone anchor 12 is movable relative to the receiver member 14 within a cone of angulation generally defined by the geometry of the distal end 32 of the receiver member and the proximal head 18 of the bone anchor 12. The exemplary bone anchor is a favored-angle polyaxial screw in which the cone of angulation is biased in one direction. In this manner, the bone anchor 12 is movable relative to the receiver member 14 in at least a first direction, indicated by arrow A in FIG. 3 and the bone anchor 12 is also movable in at least a second direction, indicated by arrow B in FIG. 3. The shaft 20 of the bone anchor 12 is movable more in the direction indicated by arrow A than in the direction indicated by arrow B. The distal shaft 20 of the bone anchor 12 defines a neutral axis with respect to the receiver member 14. In the exemplary favored-angle polyaxial screw embodiment, the neutral axis is oriented perpendicular to the plane X defined by the distal end surface 34 and intersects the center point of the opening in the distal end surface 34 through which the distal shaft 20 of the bone anchor 12 extends. The neutral axis is oriented at an angle to the central longitudinal axis L of the receiver member 14 in one exemplary manner of providing biased angulation of the bone anchor 12. In one exemplary manner of providing biased angulation, the plane Y defined by at least a portion of the proximal end surface 48 of the receiver member 14 intersects the plane X defined by at least a portion of the distal end surface 34 of the receiver member 12. In addition (or in the alternative), the proximal end 26 of the receiver member 14 may include a proximal first bore coaxial with a first central longitudinal axis N (which is coincident with longitudinal axis L) and a distal second bore coaxial with a second central longitudinal axis (which is coincident with neutral axis) and the first central longitudinal axis N and second central longitudinal axis can intersect one another. The angle between the plane X and plane Y and the angle between the first central longitudinal axis N and second longitudinal axis can be selected to provide the desired degree of biased angulation. Examples of favored angled polyaxial screws are described in more detail in U.S. Patent Application Publication 2003/0055426 and U.S. Pat. No. 6,736,820, both of which are incorporated herein by reference. In alternative embodiments, the bone anchor assembly can be a conventional (non-biased) polyaxial screw in which the bone anchor pivots in the same amount in every direction and has a neutral axis that is coincident with the central longitudinal axis L of the receiver member.

The spinal fixation element, e.g., a spinal rod 22 in FIG. 3, contacts an intermediate element, e.g., a compression member 60, positioned within the central passage 37 of the receiver member 14 and interposed between the spinal rod 22 and the proximal head 18 of the bone anchor 12 to compress the distal outer surface 38 of the proximal head 18 into direct, fixed engagement with the distal inner surface of the receiver member 18. In the exemplary embodiment, the compression member 60 includes a pair of spaced compression member apart arms 62A and 62B defining a U-shaped seat 64 for receiving the spinal rod 22 and a distal surface 66 for engaging the proximal head 18 of the bone anchor 12, as illustrated in FIGS. 3-5. Each compression member arm 62A and 62B includes an outer wall 65A,B and an inner wall 67A,B and a proximal surface 74A, 74 b of each compression member arm 62A, 62B connects the respective outer wall 65A,65B and the respective inner wall 67A, 67B. Each compression member arm 62A, 62B of the compression member 60 extends from a distal end 61 of the compression member 60 to a free end that terminates in a respective proximal surface 74A and 74B. The distal end of the compression member 60 is generally annular in shape and has a central opening 61 having a central longitudinal axis that is coincident with the central longitudinal axis L of the central passage 67 when the compression member 60 is positioned within the central passage 37 of the receiver member 14. The distal surface 66 surrounds the distal opening in the central passage 67 and is generally annular in shape when viewed from the bottom of the compression member 60.

The proximal end 26 of the receiving member 14 may be configured to receive a closure mechanism 16 positionable between and engaging the receiver member arms 28A and 28B of the receiver member 14 to capture a spinal fixation element, e.g., a spinal rod 22, within the receiver member 14, to fix the spinal rod 22 relative to the receiver member 14, and to fix the bone anchor 12 relative to the receiver member 14, as illustrated in FIG. 3. In certain exemplary embodiments, the closure mechanism 16 may be a single set screw having an outer thread for engaging an inner thread 42 provided on the receiver member arms 28A and 28B of the receiver member 14. In the exemplary embodiment, the closure mechanism 16 comprises an outer set screw 70 positionable between and engaging the receiver member arms 28A and 28B of the receiver member 14 and an inner set screw 72 positionable within the outer set screw 70. The outer set screw 70 is operable to act on the compression member 60 to fix the bone anchor 12 relative to the receiver member 14. The inner set screw 72 is operable to act on the spinal rod 22 to fix the spinal rod 22 relative to the receiver member 14. In this manner, the closure mechanism 16 permits the bone anchor 12 to be fixed relative to the receiver member 14 independently of the spinal rod 22 being fixed to the receiver member 14. In particular, the distal surface 100 of the outer set screw 70 can engage the proximal end surfaces 74A and 74B of the compression member arms 62A and 62B of the compression member 60 to force the distal surface 66 of the compression member 60 into contact with the proximal head 18 of bone anchor 12, which in turn forces the distal surface 38 of the proximal head 18 into the fixed engagement with the distal inner surface of the receiver member 14. The inner set screw 72 can engage the spinal rod 22 to force the spinal rod 22 into fixed engagement with the rod seat 64 of the compression member 60.

The outer set screw 70 of the exemplary closure mechanism 16 includes a first outer thread 76 for engaging the complementary inner thread 42 on the receiver member arms 28A and 28B of the receiver member 14. The thread form for the first outer thread 76 and the inner thread 42, including the number of threads, the pitch, major and minor diameter, and thread shape, may be selected to facilitate connection between the components and transfer of the desired axial tightening force. In the illustrated embodiment, for example, the first outer thread 76 and the inner thread 42 are square threads. Further exemplary thread forms are described in commonly-owned U.S. Patent Application Publication No. 2013-0096618, filed Oct. 9, 2012, which is incorporated herein by reference.

The outer set screw 70 may have a central passage 96 from a proximal surface 98 of the outer set screw 70 to a distal surface 100 of the outer set screw 74 for receiving the inner set screw 72. The central passage 96 may have an inner thread 102 for engaging a complementary outer thread 104 on the inner set screw 72. The thread form for the inner thread 102 and the outer thread 104, including the number of threads, the pitch, major and minor diameter, and thread shape, may be selected to facilitate connection between the components and transfer of the desired axial tightening force. In the illustrated embodiment, for example, the inner thread 102 and the outer thread 104 are M7×1 metric threads.

The proximal surface 98 of the outer set screw 70 may have one or more drive features to facilitate rotation and advancement of the outer set screw 74 relative to the receiver member 14. In the exemplary embodiment, the drive features are a plurality of cut-outs spaced-apart about the perimeter of the top surface 98. In the inner set screw 72 may include drive feature for receiving an instrument to rotate and advance the inner set screw 72 relative to the outer set screw 74. In the illustrated embodiment, for example, the inner set screw 72 includes a central passage 108 having a plurality of spaced apart, longitudinally oriented cut-outs for engaging complementary features on an instrument.

The exemplary bone anchor assembly 10 may be used with a spinal fixation element such as rigid spinal rod 22. The spinal rod 22 may be constructed from titanium, titanium alloys, stainless steel, cobalt chrome, PEEK, or other materials suitable for rigid fixation. Alternatively, the spinal fixation element may be a dynamic stabilization member that allows controlled mobility between the instrumented vertebrae.

As discussed above, engagement of the outer set screw 70 with the receiver member arms 28A and 28B results in the distal surface 100 of the outer set screw 70 engaging the proximal surface 74A and 74B of the compression member arms 62A and 62B. The outer set screw 70 thereby delivers a distal force to the compression member 60 that is transmitted through the compression member 60 to fix the bone anchor 12 relative to the receiver member 14. The proximal surfaces 74A and 74B of the compression member arms 62A and 62 can have a shape configured to restrict deformation of the compression member arms 62A and 62B, in particular, separation or splaying of the compression member arms 62A and 62B (i.e., movement of the arms away from each other) or movement of the compression member arms 62A and 62 towards each other, during or as a result of tightening, by primarily directing the distal force from the compression member in direction parallel to the central longitudinal axis L and inhibiting transmission of the distal force in a direction non-parallel to the central longitudinal axis L, particularly in a direction away from the central longitudinal axis L. The distal surface 66 of the outer set screw 70 can have a shape that is complementary to the shape of the proximal surfaces 74A and 74B of the compression member arms 62A and 62B. In the exemplary embodiment illustrated in FIGS. 1-5, the proximal surface 74A and 74B of each compression member arm 62 A and 62B is convex in shape and the distal surface 66 of the outer set screw 70 is concave in shape. In the exemplary embodiment, the convex proximal surfaces 74A and 74B have a single, constant radius from the respective outer surface 65A and 65B and the respective inner surface 67A and 67B and the concave distal surface 66 has a constant radius equal to the radius of the convex proximal surfaces 74A and 74B.

In prior art bone anchor assembly designs, as illustrated in FIG. 26, the distal surface 902 of the outer set screw 904 and the proximal surfaces 908A and 908B of the compression member arms 910A and 910B are flat surfaces. The interface between the distal surface 902 and the proximal surfaces 908A and 908B fails to limit or minimize transmission of the axial tightening force in a non-axial direction and therefore fails to minimize or limit the deformation, in particular, the separation or splaying of the compression member arms 910A and 910B during axially tightening of the outer set screw 904. In contrast, the concave and convex interface of the exemplary embodiment illustrated in FIGS. 1-5, effectively restricts the deformation of the compression member 60 and, in particular, the movement of the compression member arms 62A and 62B relative each other (e.g., both towards and away from each other). By doing so, instances of the closure mechanism 16 loosening over time are reduced.

FIGS. 6-9 illustrate another exemplary bone anchor assembly 210 in which the proximal surfaces 274A and 274B of each compression member arm 262A and 262B of the compression member 260 has a peaked shape. Each peaked proximal surface 274A and 274B having a first angled surface 275A and 275B that intersects a second angled surface 277A and 277B at a peak 279A and 279B. In the exemplary embodiment, the distal surface 300 of the outer set screw 270 includes a third angled surface 302 that intersects an fourth angled surface 304 to define a V-shaped distal surface 300 complementary in shape to the peaked proximal surfaces 274A and 274B. For example, the angle of the first angled surface 275A and 275B relative to a central longitudinal axis of the compression member 210 (which is coincident with the central longitudinal axis L of the receiver member 14 when the compression member 260 is positioned within the central passage 37 of the receiver member 14) is equal to the angle of the third angled surface 302 relative to the central longitudinal axis of the outer set screw 270 and the angle of the second angled surface 277 A and 277B relative to the central longitudinal axis of the compression member 260 is equal to the angle of the fourth angled surface 304 relative to the central longitudinal axis of the outer set screw 270. The peaked interface between the proximal surfaces 274A and 274B of the compression member arms 262A and 262B and the distal surface 300 of the outer set screw, like the concave/convex interface described above, effectively restricts the deformation of the compression member 260 and, in particular, movement of the compression member arms 262A and 262B relative to each other.

FIGS. 10-12 illustrate another exemplary bone anchor assembly 410 in which the proximal surfaces 474A and 474B of each compression member arm 462A and 462B of the compression member 460 is angled from the respective outer wall 465A and 467B to the respective inner wall 467A and 467B. The distal surface 500 of the outer set screw 470 is conical in shape having an angle that is complementary to the angle of the angled proximal surfaces 474A and 474B. The peaked interface between the proximal surfaces 474A and 474B of the compression member arms 462A and 462B and the distal surface 506 of the outer set screw, like the concave/convex interface described above, effectively restricts the deformation of the compression member 460 and, in particular, movement of the compression member arms 462A and 462B relative to each other.

FIG. 14 illustrates another exemplary bone anchor assembly 610 in which the proximal surfaces 674A and 674B of each compression member arm 662A and 662B of the compression member 660 is stepped in shape and has a centrally raised surface 681A and 681B. The distal surface of the outer set screw 670 includes an annular recess 671 that is complementary in size and shape to the centrally raised surface 681A and 681B proximal surfaces 674A and 674B. The centrally raised surface 681A and 681B proximal surfaces 674A and 674B seats within the annular recess 671 thereby restricting the deformation of the compression member 660 and, in particular, movement of the compression member arms 662A and 662B relative to each other.

FIGS. 15-25 illustrates other exemplary bone anchor assemblies in which the proximal surfaces or the compression member arms and the distal surface of the outer set screw are complementarily configured to restrict the deformation of the compression member and, in particular, movement of the compression member arms relative to each other.

In the exemplary bone anchor assembly 1010 of FIG. 15, the distal surface 1000 of the outer set screw 1070 is convex in shape and the proximal surfaces of 1074A and 1074B of the compression member arms are concave in shape. In the exemplary embodiment, the convex distal surface 1000 and the respective concave proximal surfaces 1074A and 1074B each have a constant radius that extends across the entire surface (when viewed in cross section as in FIG. 15) from the outer edge to the inner edge of the surface. In the exemplary embodiment, the radius of the convex distal surface 1000 and radius of the respective concave proximal surfaces 1074A and 1074B are equal. The exemplary bone anchor assembly 1010 further includes a drag member in the form of a split elastomeric ring 995 that is positioned within an annular groove 997 formed in the inner wall of the receiver member 14. The groove 997 and, thus the ring 995, is positioned within the receiver member 14 such that the ring 995 engages the proximal head 18 of the bone anchor 12 above the center point CP of the head 18 or above a line 1002 that intersects the center point CP of the head 18 and is oriented orthogonal to the longitudinal axis of receiver member 14 when the bone anchor 12 is in the neutral position, as illustrated in FIG. 15.

In the exemplary bone anchor assembly 1110 of FIG. 16, the distal surface 1100 of the outer set screw 1170 includes a projection that is convex in shape and the proximal surfaces of 1174A and 1174B of the compression member arms each include a complementary shaped concave recess in which the convex projection on the distal surface 1100 of the outer set screw can be seated.

In the exemplary bone anchor assembly 1210 of FIG. 17, the proximal surfaces of 1274A and 1274B of the compression member arms each include a convex projection and the distal surface 1200 of the outer set screw 1270 includes a complementary shaped concave recess or groove in which the convex projections on the proximal surfaces 1274A and 1274B can be seated.

In the exemplary bone anchor assembly 1310 of FIG. 18, the distal surface 1300 of the outer set screw 1370 includes a projection that is convex in shape and the proximal surfaces 1374A and 1374B of the compression member arms each have a rectilinear shaped groove (when viewed in cross section as in FIG. 18) that receives the convex projection of the distal surface 1300 of the outer set screw 1370.

In the exemplary bone anchor assembly 1410 of FIG. 19, the proximal surfaces of 1474A and 1474B of the compression member arms each include a convex projection and the distal surface 1400 of the outer set screw 1470 includes a V-shaped recess or groove that receives the convex projections on the proximal surfaces of 1474A and 1474B.

In the exemplary bone anchor assembly 1510 of FIG. 20, the distal surface 1500 of the outer set screw 1570 is peaked having a first angled surface that intersects a second angled surface at a peak and the proximal surfaces of 1574A and 1574B of the compression member arms are concave in shape.

In the exemplary bone anchor assembly 1610 of FIG. 21, the distal surface 1600 of the outer set screw 1670 includes a projection that is convex in shape and the proximal surfaces 1674A and 1674B of the compression member arms each have a V-shaped groove (when viewed in cross section as in FIG. 21) that receives the convex projection of the distal surface 1600 of the outer set screw 1670.

In the exemplary bone anchor assembly 1710 of FIG. 22, the distal surface 1700 of the outer set screw 1770 includes a projection that is rectilinear in shape and the proximal surfaces 1774A and 1774B of the compression member arms each have a complementary shaped rectilinear groove (when viewed in cross section as in FIG. 22) that receives the rectilinear projection of the distal surface 1700 of the outer set screw 1770.

In the exemplary bone anchor assembly 1810 of FIG. 23, the distal surface 1800 of the outer set screw 1870 has a peaked projection that has a first angled surface that intersects a second angled surface at a peak and the proximal surfaces 1874A and 1874B of the compression member arms each have a complementary shaped V-shaped groove (when viewed in cross section as in FIG. 23) that receives the peaked shaped projection of the distal surface 1800 of the outer set screw 1870.

In the exemplary bone anchor assembly 1910 of FIG. 24, the distal surface 1900 of the outer set screw 1970 is peaked having a first angled surface that intersects a second angled surface at a peak and the proximal surfaces 1974A and 1974B of the compression member arms are V-shaped (when viewed in cross section as in FIG. 24).

In the exemplary bone anchor assembly 2010 of FIG. 25, the proximal surfaces 2084A and 2084B of the compression member arms each have a peaked projection that has a first angled surface that intersects a second angled surface at a peak and the distal surface 2000 of the outer set screw 2070 has a complementary shaped V-shaped groove (when viewed in cross section as in FIG. 25) that receives the peaked shaped projections of the proximal surfaces 2084A and 2084B.

While the devices and methods of the present invention have been particularly shown and described with reference to the exemplary embodiments thereof, those of ordinary skill in the art will understand that various changes may be made in the form and details herein without departing from the spirit and scope of the present invention. Those of ordinary skill in the art will recognize or be able to ascertain many equivalents to the exemplary embodiments described specifically herein by using no more than routine experimentation. Such equivalents are intended to be encompassed by the scope of the present invention and the appended claims. 

The invention claimed is:
 1. A bone anchor assembly comprising: a bone anchor having a proximal head and a distal shaft configured to engage bone, a receiver member for receiving a spinal fixation element to be coupled to the bone anchor, the receiver member having a proximal end having a pair of spaced apart receiver member arms defining a recess therebetween, the receiver member arms including an inner thread, a distal end having a distal end surface defining an opening through which at least a portion of the bone anchor extends, and a central passage extending between the proximal end and the distal end, the central passage communicating with the opening in the distal end surface, the central passage having a central longitudinal axis extending between the proximal end and the distal end, a compression member positioned within the receiver member, the compression member having a proximal end and a distal end, the proximal end of the compression member having a pair of spaced apart compression member arms defining a U-shaped seat for receiving the rod, each compression member arm having a proximal surface, the distal end of the compression member having a distal surface engageable with the proximal head of the bone anchor, an outer set screw positionable between and engaging the receiver member arms, the outer set screw including a first outer thread for engaging the inner thread, the outer set screw having a distal surface engageable with the proximal surface of the compression member arms, the outer set screw having a set screw central passage from a top surface of the outer set screw to a bottom surface of the outer set screw, the set screw central passage having a second internal thread, and an inner set screw positionable within the set screw central passage, the inner set screw having a second outer thread for engaging the second inner thread, the inner set screw operable to act on the spinal rod to fix the spinal rod relative to the receiver member; wherein engagement of the outer set screw with the receiver member arms results in the distal surface of the outer set screw engaging the proximal surface of the compression member arms and the outer set screw thereby delivering a distal force to the compression member to fix the bone anchor relative to the receiver member, the proximal surface of the compression member arms having a shape configured to restrict relative movement of the compression member arms both towards and away from each other and the distal surface of the outer set screw having a shape that is complementary to the shape of the proximal surface of the compression member arms; wherein each compression member arm includes an outer wall and an inner wall, the proximal surface of the compression member arm connecting the outer wall and the inner wall; and wherein the proximal surface of each compression member arm is peaked, each peaked surface having a first angled surface that intersects a second angled surface at a peak.
 2. The bone anchor assembly of claim 1, wherein the distal surface of the outer set screw includes a third angled surface that intersects a fourth angled surface to define a V-shaped surface.
 3. The bone anchor assembly of claim 2, wherein the angle of the first angled surface relative to the central longitudinal axis is equal to the angle of the third angled surface relative to the central longitudinal axis and the angle of the second angled surface relative to the central longitudinal axis is equal to the angle of the fourth angled surface relative to the central longitudinal axis.
 4. The bone anchor assembly of claim 1, wherein the bone anchor is movable relative to the receiver member.
 5. The bone anchor assembly of claim 4, wherein the bone anchor is movable relative to the receiver member in at least a first direction at a first angle to relative to a central longitudinal axis and in at least a second direction at a second angle relative to the central longitudinal axis, the second angle being greater than the first angle.
 6. The bone anchor assembly of claim 1, wherein the proximal end of the receiver member includes a proximal end surface that defines a first plane and wherein the distal end surface defines a second plane, the first plane and second plane intersecting one another.
 7. A bone anchor assembly comprising: a bone anchor having a proximal head and a distal shaft configured to engage bone, a receiver member for receiving a spinal fixation element to be coupled to the bone anchor, the receiver member having a proximal end having a pair of spaced apart receiver member arms defining a recess therebetween, the receiver member arms including an inner thread, a distal end having a distal end surface defining an opening through which at least a portion of the bone anchor extends, and a central passage extending between the proximal end and the distal end, the central passage communicating with the opening in the distal end surface, the central passage having a central longitudinal axis extending between the proximal end and the distal end, a compression member positioned within the receiver member, the compression member having a proximal end and a distal end, the proximal end of the compression member having a pair of spaced apart compression member arms defining a U-shaped seat for receiving the rod, each compression member arm having a proximal surface, the distal end of the compression member having a distal surface engageable with the proximal head of the bone anchor, an outer set screw positionable between and engaging the receiver member arms, the outer set screw including a first outer thread for engaging the inner thread, the outer set screw having a distal surface engageable with the proximal surface of the compression member arms, the outer set screw having a set screw central passage from a top surface of the outer set screw to a bottom surface of the outer set screw, the set screw central passage having a second internal thread, and an inner set screw positionable within the set screw central passage, the inner set screw having a second outer thread for engaging the second inner thread, the inner set screw operable to act on the spinal rod to fix the spinal rod relative to the receiver member; wherein engagement of the outer set screw with the receiver member arms results in the distal surface of the outer set screw engaging the proximal surface of the compression member arms and the outer set screw thereby delivering a distal force to the compression member to fix the bone anchor relative to the receiver member, the proximal surface of the compression member arms having a shape configured to restrict relative movement of the compression member arms both towards and away from each other and the distal surface of the outer set screw having a shape that is complementary to the shape of the proximal surface of the compression member arms; wherein each compression member arm includes an outer wall and an inner wall, the proximal surface of the compression member arm connecting the outer wall and the inner wall; and wherein the proximal surface of each compression member arm is stepped having a centrally raised surface.
 8. A bone anchor assembly comprising: a bone anchor having a proximal head and a distal shaft configured to engage bone, a receiver member for receiving a spinal fixation element to be coupled to the bone anchor, the receiver member having a proximal end having a proximal end surface and a pair of spaced apart receiver member arms defining a recess therebetween for receiving a spinal rod, the arms including a first inner thread, the proximal end surface defining a first plane, a distal end having a distal end surface defining an opening through which at least a portion of the bone anchor extends, the bone anchor being movable relative to the receiver member, the distal end surface defining a second plane, the first plane and the second plane intersecting one another, a compression member positioned within a central passage of the receiver member, the compression member having a proximal end and a distal end, the proximal end of the compression member having a pair of spaced apart compression member arms defining a U-shaped seat for receiving the rod, each compression member arm including an outer wall, an inner wall and a proximal surface connecting the outer wall and the inner wall, the distal end of the compression member having a distal surface engageable with the proximal head of the bone anchor, an outer set screw positionable between and engaging the receiver member arms, the outer set screw including a first outer thread for engaging the first inner thread, the outer set screw having a distal surface engageable with the proximal surface of the compression member arms, the outer set screw having a set screw central passage from a top surface of the outer set screw to a bottom surface of the outer set screw, the set screw central passage having a second internal thread, and an inner set screw positionable within the set screw central passage, the inner set screw having a second outer thread for engaging the second inner thread, the inner set screw operable to act on the spinal rod to fix the spinal rod relative to the receiver member; wherein engagement of the outer set screw with the receiver member arms results in the distal surface of the outer set screw engaging the proximal surface of the compression member arms and the outer set screw thereby delivering a distal force to the compression member to fix the bone anchor relative to the receiver member, the proximal surface of the compression member arms having a shape configured to restrict relative motion of the compression member arms both towards and away from each other, the distal surface of the outer set screw having a shape that is complementary to the shape of the proximal surface of the compression member arms; and wherein the proximal surface of each compression member arm is peaked, each peaked surface having a first angled surface that intersects a second angled surface at a peak.
 9. The bone anchor assembly of claim 8, wherein the distal surface of the outer set screw includes a third angled surface that intersects a fourth angled surface to define a V-shaped surface.
 10. The bone anchor assembly of claim 9, wherein the angle of the first surface relative to the central longitudinal axis is equal to the angle of the third angled surface relative to the central longitudinal axis and the angle of the second surface relative to the central longitudinal axis is equal to the angle of the fourth angled surface relative to the central longitudinal axis.
 11. A bone anchor assembly comprising: a bone anchor having a proximal head and a distal shaft configured to engage bone, a receiver member for receiving a spinal fixation element to be coupled to the bone anchor, the receiver member having a proximal end having a proximal end surface and a pair of spaced apart receiver member arms defining a recess therebetween for receiving a spinal rod, the arms including a first inner thread, the proximal end surface defining a first plane, a distal end having a distal end surface defining an opening through which at least a portion of the bone anchor extends, the bone anchor being movable relative to the receiver member, the distal end surface defining a second plane, the first plane and the second plane intersecting one another, a compression member positioned within a central passage of the receiver member, the compression member having a proximal end and a distal end, the proximal end of the compression member having a pair of spaced apart compression member arms defining a U-shaped seat for receiving the rod, each compression member arm including an outer wall, an inner wall and a proximal surface connecting the outer wall and the inner wall, the distal end of the compression member having a distal surface engageable with the proximal head of the bone anchor, an outer set screw positionable between and engaging the receiver member arms, the outer set screw including a first outer thread for engaging the first inner thread, the outer set screw having a distal surface engageable with the proximal surface of the compression member arms, the outer set screw having a set screw central passage from a top surface of the outer set screw to a bottom surface of the outer set screw, the set screw central passage having a second internal thread, and an inner set screw positionable within the set screw central passage, the inner set screw having a second outer thread for engaging the second inner thread, the inner set screw operable to act on the spinal rod to fix the spinal rod relative to the receiver member; wherein engagement of the outer set screw with the receiver member arms results in the distal surface of the outer set screw engaging the proximal surface of the compression member arms and the outer set screw thereby delivering a distal force to the compression member to fix the bone anchor relative to the receiver member, the proximal surface of the compression member arms having a shape configured to restrict relative motion of the compression member arms both towards and away from each other, the distal surface of the outer set screw having a shape that is complementary to the shape of the proximal surface of the compression member arms; and wherein the proximal surface of each compression member arm is stepped having a centrally raised surface. 